狼疮肾炎治疗目标的研究

Research about the goals of treatment of lupus nephritis

目的探讨狼疮肾炎的治疗目标。方法３２例狼疮肾炎患者进入研究，其中２７例接受肾活检。治疗分为三期：（１）首始治疗期；（２）持续治疗期；（３）维持治疗期。制定数个等级的治疗缓解目标并追踪（４８±１０）月。结果２０／３２例患者达完全缓解，Ｓｃｒ从（３５３±１１５）降至（１１０±７６）μｍｏｌ／Ｌ（Ｐ＜０００１），尿蛋白从（８６±４５）减少至（１５＋０９）ｇ／ｄ（Ｐ＜００１）。９例复发（２８１％）。至追踪期末，有２例分别进入氮质血症期和尿毒症期。结论狼疮肾炎的治疗目标是达到最大的治疗利益和最少药物副作用之间的平衡。要求达到实验室和临床的完全缓解是不现实的，应注意避免过度治疗带来的各种危险的副作用。

Objective To clarify the goals of treatment of lupus nephritis. Methods 32 patients with LN were studied.Renal biopsies were performed in 27/32 of them.Treatment was structured in 3 phase:(1)pulse treatment phase; (2)continuous treatment phase;(3)maintenance treatment phase. Primary from several targets was geparated and patients were followed up for 4810 months. Results 20/32 patients achieved remission of glomerulonephritis,the others partly remission. Serum creatinine fell from (353115) to(11076)mol/L(P<00001).Proteinuria decreased from(8.64)to (1509)g/d(P<001). 9 patients relapsed (281%), 2 later progressed to azotemia and end-stage renal failure, respectively. Conclusion The goals of treatment of lupus nephritis are aimed more at reaching a favourable balance between benefits and sideeffects,The symptomatic control to the point of allowing a goal quality of life and an acceptable lifestyle rather than pursuing the healing or a complete well belling at the cost of more risky complications. It is unrealistic to pursue the full clinical and laboratory regression of the disease.